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Table.  Compliance With Underage Access and Marketing Restrictions in 700 Recreational Cannabis Dispensaries in California, 2019a
Compliance With Underage Access and Marketing Restrictions in 700 Recreational Cannabis Dispensaries in California, 2019a
1.
Ammerman  S, Ryan  S, Adelman  WP; Committee on Substance Abuse, Committee on Adolescence.  The impact of marijuana policies on youth: clinical, research, and legal update.   Pediatrics. 2015;135(3):584-587. doi:10.1542/peds.2014-4147 PubMedGoogle ScholarCrossref
2.
Cao  Y, Carrillo  AS, Zhu  SH, Shi  Y.  Point-of-sale marketing in recreational marijuana dispensaries around California schools.   J Adolesc Health. 2020;66(1):72-78. doi:10.1016/j.jadohealth.2019.07.023 PubMedGoogle ScholarCrossref
3.
Cao  Y, Carrillo  AS, Jankowska  MM, Shi  Y.  Validation of secondary data sources for enumerating marijuana dispensaries in a state commercializing marijuana.   Drug Alcohol Depend. 2020;215:108183. doi:10.1016/j.drugalcdep.2020.108183 PubMedGoogle Scholar
4.
Pedersen  ER, Firth  C, Parker  J,  et al.  Locating medical and recreational cannabis outlets for research purposes: online methods and observational study.   J Med Internet Res. 2020;22(2):e16853. doi:10.2196/16853 PubMedGoogle Scholar
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    Research Letter
    August 16, 2021

    Assessment of Recreational Cannabis Dispensaries’ Compliance With Underage Access and Marketing Restrictions in California

    Author Affiliations
    • 1Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla
    • 2Sol Price School of Public Policy and Leonard D. Schaeffer Center for Health Policy & Economics, University of Southern California, Los Angeles
    JAMA Pediatr. 2021;175(11):1178-1180. doi:10.1001/jamapediatrics.2021.2508

    The increasing availability of cannabis to adults through legalization of recreational cannabis dispensaries (RCDs) raises concerns regarding underage access and exposure to products and marketing. The American Academy of Pediatrics “strongly recommends strict enforcement of rules and regulations that limit access, marketing, and advertising to youth.”1 Currently, all legalizing states prohibit sales to minors and require an identification (ID) check, and most ban marketing activities appealing to children.2 However, little is known about whether cannabis retailers comply. We assessed the compliance of RCDs with underage access and marketing restrictions in California.

    Methods

    In this cross-sectional study, a research team at University of California, San Diego identified and audited all the RCDs in California statewide (N = 700) between June 15 and September 15, 2019. The institutional review board at the University of California San Diego deemed this study nonhuman-subject research; therefore, this study was not subject to an institutional review board approval. This study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guideline.

    A validated approach was used to construct a comprehensive list of RCDs.3 We complemented the state licensing directory with online crowdsourcing platforms, given research showing that more than half of active dispensaries in Los Angeles operated without a state-issued license.4 Trained researchers called dispensaries to verify the location, operation status, and requirements about patient ID card and doctor’s recommendation.

    A validated instrument, the Standardized Marijuana Dispensary Assessment–Children Focused (SMDA-CF), was adapted to audit the call-verified RCDs.2 The SMDA-CF includes items on underage access and point-of-sale marketing activities, with particular attention to those appealing to children. The SMDA-CF items have moderate to high reliability overall, with a median κ score of 0.8.2 Trained researchers (aged 21-23 years) conducted the audits undercover in teams of 2 to improve data reliability. Observations on each dispensary were recorded right after the visit.

    All data are reported as counts and proportions. Because our data included the universe of RCDs in California, no confidence intervals or other estimated statistics are reported. Statistical package Stata 16 (StataCorp LLC) was used for the analysis.

    Results

    Of the 700 RCDs assessed, 475 (67.9%) failed to comply with California laws requiring age-limit signage. California laws further require ID check before any purchase, and overall compliance with this rule was high at 678 RCDs (96.8%). However, only 82 (11.7%) checked ID before entry. The majority (596 [85.1%]) checked ID after entry, where additional marketing items were displayed. Despite a low violation rate of child-appealing marketing restrictions on the exterior of the RCDs, 247 (35.3%) had marketing items that appealed to children inside the RCDs. Product promotions were common at 600 (85.7%), with 440 (62.9%) providing first-time purchase discounts and 340 (48.6%) providing weekly or daily deals. Violations of the free-sample ban were also common (151 [21.6%] for take-away items; 113 [16.1%] for on-site consumption). Furthermore, 391 RCDs (55.8%) provided branded marketing materials and 272 (38.9%) promoted health benefits of cannabis (Table).

    Discussion

    Although RCDs in California were generally compliant with checking IDs, most RCDs did not check them until customers entered the premises. Considering the low rate of compliance with age-limit signage, minors may unintentionally or even intentionally enter RCDs. On entrance, they become exposed to marketing items hidden from casual outside observers, including advertisements, products, packages, and paraphernalia appealing to children; price promotions; free samples; brand awareness; and positive messaging. Limitations of this study include that the authors used California-specific, cross-sectional data with possibly limited generalizability, binary indicators of instruments without quantity information, and subjective evaluation of child-appealing items. The findings of this cross-sectional study suggest that, as more states liberalize cannabis, greater emphasis and resources must be dedicated to enforcement of random compliance checks to ensure that regulations aiming to minimize access and exposure to minors have the intended effects.

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    Article Information

    Accepted for Publication: May 6, 2021.

    Published Online: August 16, 2021. doi:10.1001/jamapediatrics.2021.2508

    Corresponding Author: Yuyan Shi, PhD, Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, 9500 Gilman Dr, La Jolla, CA 92093-0628 (yus001@ucsd.edu).

    Author Contributions: Dr Shi had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

    Concept and design: Shi.

    Acquisition, analysis, or interpretation of data: Both authors.

    Drafting of the manuscript: Both authors.

    Critical revision of the manuscript for important intellectual content: Both authors.

    Statistical analysis: Shi.

    Obtained funding: Shi.

    Administrative, technical, or material support: Shi.

    Supervision: Shi.

    Conflict of Interest Disclosures: None reported.

    Funding/Support: This study was supported by grant 27IR-0014 from the Tobacco-Related Disease Research Program and grant R01DA042290 from the National Institute on Drug Abuse (Dr Shi).

    Role of the Funder/Sponsor: The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

    Additional Contributions: We thank Yiwen Cao, PhD, Angelina Carrillo, MPH, Grace Tran, BS, Anh Van Vo, BS, Tina Le, BS, Shelton Lo, MPH, and Longines Lee, BS for data collection. All contributors were from the Department of Family Medicine and Public Health, University of California San Diego, and all were compensated for their time.

    References
    1.
    Ammerman  S, Ryan  S, Adelman  WP; Committee on Substance Abuse, Committee on Adolescence.  The impact of marijuana policies on youth: clinical, research, and legal update.   Pediatrics. 2015;135(3):584-587. doi:10.1542/peds.2014-4147 PubMedGoogle ScholarCrossref
    2.
    Cao  Y, Carrillo  AS, Zhu  SH, Shi  Y.  Point-of-sale marketing in recreational marijuana dispensaries around California schools.   J Adolesc Health. 2020;66(1):72-78. doi:10.1016/j.jadohealth.2019.07.023 PubMedGoogle ScholarCrossref
    3.
    Cao  Y, Carrillo  AS, Jankowska  MM, Shi  Y.  Validation of secondary data sources for enumerating marijuana dispensaries in a state commercializing marijuana.   Drug Alcohol Depend. 2020;215:108183. doi:10.1016/j.drugalcdep.2020.108183 PubMedGoogle Scholar
    4.
    Pedersen  ER, Firth  C, Parker  J,  et al.  Locating medical and recreational cannabis outlets for research purposes: online methods and observational study.   J Med Internet Res. 2020;22(2):e16853. doi:10.2196/16853 PubMedGoogle Scholar
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